Early Effects of Ivabradine and B-Blocker Therapy Versus B-Blocker Uptitration on Exercise Tolerance, LV Systolic Function and Pulse Wave Augmentation in Stable Cad Patients

摘要

Introduction: The heart rate (HR) at rest is considered to be major factor determining the need of myocardium in oxygen, and its increase is associated with a significant elevation in cardiovascular and total mortality in patients with coronary artery disease (CAD) [1-2]. The association of "pure" HR reduction with prognosis improvement in patients with stable CAD, CHFII-IV NYHA class with lowered EF and sinus rhythm >70 bpm was confirmed by the results of the randomized multicenter placebo-controlled BEAUTIFUL study (subgroup analysis) [3], and the SHIFT trial [4]. In both of them HR reduction, as a therapeutic goal, was achieved by addition to standard evidence-based therapy, including maximal tolerated doses of BB, of ivabradine - specific inhibitor of the sinus node pacemaker If current. We hypothized, however, that purposeful utilization of such drug combination for HR control, compared to full-dose BB therapy, could have certain hemodynamic advantages due to the less pronounced negative inotropic and vasoconstrictive effects of the lower-dose BB.